A Prototype Model Using Clinical Document Architecture (CDA) with a Japanese Local Standard : Designing and Implementing a Referral Letter System

Since clinical document architecture (CDA) became an American National Standards Institute (ANSI)-approved health level seven (HL7) Standard, many countries have begun making an eff ort to make local standards conform to CDA. In order to make CDA compatible with the many diff erent local standards existing in diff erent countries, we designed a prototype model using HL7 CDA R2 with medical markup language (MML), a Japanese medical data exchange standard. Furthermore, a referral letter system based on this model was developed. Archetypes were used to express medical concepts in a formal manner and to make 2 diff erent standards work collaboratively. We share herein the experience gathered in designing and implementing a referral letter system based on HL7 CDA, Release 2 (CDA R2). We also outline the challenges encountered in our project and the opportunities to widen the scope of this approach to other clinical documents.</p

An electronic health record to support patients and institutions of the health care system

The department of Medical Informatics of the University Hospital Münster and the Gesakon GmbH (an university offspring) initiated the cooperative development of an electronic health record (EHR) called "akteonline.de" in 2000. From 2001 onwards several clinics of the university hospital have already offered this EHR (within pilot projects) as an additional service to selected subsets of their patients. Based on the experiences of those pilot projects the system architecture and the basic data model underwent several evolutionary enhancements, e.g. implementations of electronic interfaces to other clinical systems (considering for example data interchange methods like the Clinical Document Architecture - standardized within the HL7 group - and also interfacing architectures of German GP systems, such as VCS and D2D). "akteonline.de" in its current structure supports patients as well as health care professionals and aims at providing a collaborative health information system which perfectly supports the clinical workflow even across institutional boundaries and including the patient himself. Since such an EHR needs to strictly fulfill high data security and data protection requirements, a complex authorization and access control component has been included. Furthermore the EHR data are encrypted within the database itself and during their transfer across the internet

Exchanging Appointment Data Among Healthcare Institutions

The introduction of national electronic patient records such as the electronic patient dossier EPD in Switzerland provides a new basis for digitizing healthcare processes at a national level. One process however, that is currently neglected within the Swiss EPD, is the scheduling process in healthcare. The objective of this work is to analyze the appointment scheduling process and the involved IT systems in order to develop an appointment data structure and a concept for cross-institutional exchange of appointment data. The analysis showed that various outpatient and inpatient information systems support appointment booking through proprietary solutions. A true standard for appointment data exchange is missing. We suggest an appointment data structure and a corresponding data exchange process based on the FHIR standard. In its current implementation, the Swiss EPD does not support this proposed appointment scheduling process. We discuss how potential additions such as the IHE Care Services Discovery (CSD) profile can provide better compatibility

Combining ontologies and open standards to derive a middle layer information model for interoperability of personal and electronic health records

Objectives: To enable better interoperability between Personal Health Record (PHR) and Electronic Health Record (EHR) systems to allow exchange of data from patients to providers and vice versa in order to encourage PHR use and patient self-management. Methods: A non-binding middleware based on open technologies and standards that resides between a PHR and EHR system has been developed. Specifically, the middleware consists of an ontology-driven information model based on the HL7 Reference Information Model (RIM) and a set of transformation rules that work in conjunction with the information model to process data exported from a PHR or EHR system and prepare it according to constraints imposed by the receiving system. Results: The information model was evaluated by executing a set of use case scenarios containing data exported from a PHR system, transformed according to the transformation rules, transferred to an EHR system and vice versa (EHR to PHR). This allowed various challenges to emerge as well as revealed gaps in current standards in use. Conclusions: The proposed middleware information model offers a number of advantages. When modifications are made to either a PHR or EHR system, they can be incorporated by altering only the instantiation of the information model. The model uses classes and attributes based on HL7 RIM to define how data is captured which allows greater flexibility in how data can be manipulated by receiving systems. The solution is applicable to existing PHR systems, or could be used as a blueprint to develop new PHR applications

Design and Implementation of a Collaborative Clinical Practice and Research Documentation System Using SNOMED-CT and HL7-CDA in the Context of a Pediatric Neurodevelopmental Unit

This paper introduces a prototype for clinical research documentation using the structured information model HL7 CDA and clinical terminology (SNOMED CT). The proposed solution was integrated with the current electronic health record system (EHR-S) and aimed to implement interoperability and structure information, and to create a collaborative platform between clinical and research teams. The framework also aims to overcome the limitations imposed by classical documentation strategies in real-time healthcare encounters that may require fast access to complex information. The solution was developed in the pediatric hospital (HP) of the University Hospital Center of Coimbra (CHUC), a national reference for neurodevelopmental disorders, particularly for autism spectrum disorder (ASD), which is very demanding in terms of longitudinal and cross-sectional data throughput. The platform uses a three-layer approach to reduce components’ dependencies and facilitate maintenance, scalability, and security. The system was validated in a real-life context of the neurodevelopmental and autism unit (UNDA) in the HP and assessed based on the functionalities model of EHR-S (EHR-S FM) regarding their successful implementation and comparison with state-of-the-art alternative platforms. A global approach to the clinical history of neurodevelopmental disorders was worked out, providing transparent healthcare data coding and structuring while preserving information quality. Thus, the platform enabled the development of user-defined structured templates and the creation of structured documents with standardized clinical terminology that can be used in many healthcare contexts. Moreover, storing structured data associated with healthcare encounters supports a longitudinal view of the patient’s healthcare data and health status over time, which is critical in routine and pediatric research contexts. Additionally, it enables queries on population statistics that are key to supporting the definition of local and global policies, whose importance was recently emphasized by the COVID pandemic.info:eu-repo/semantics/publishedVersio

Comparative study of healthcare messaging standards for interoperability in ehealth systems

Advances in the information and communication technology have created the field of "health informatics," which amalgamates healthcare, information technology and business. The use of information systems in healthcare organisations dates back to 1960s, however the use of technology for healthcare records, referred to as Electronic Medical Records (EMR), management has surged since 1990’s (Net-Health, 2017) due to advancements the internet and web technologies. Electronic Medical Records (EMR) and sometimes referred to as Personal Health Record (PHR) contains the patient’s medical history, allergy information, immunisation status, medication, radiology images and other medically related billing information that is relevant. There are a number of benefits for healthcare industry when sharing these data recorded in EMR and PHR systems between medical institutions (AbuKhousa et al., 2012). These benefits include convenience for patients and clinicians, cost-effective healthcare solutions, high quality of care, resolving the resource shortage and collecting a large volume of data for research and educational needs. My Health Record (MyHR) is a major project funded by the Australian government, which aims to have all data relating to health of the Australian population stored in digital format, allowing clinicians to have access to patient data at the point of care. Prior to 2015, MyHR was known as Personally Controlled Electronic Health Record (PCEHR). Though the Australian government took consistent initiatives there is a significant delay (Pearce and Haikerwal, 2010) in implementing eHealth projects and related services. While this delay is caused by many factors, interoperability is identified as the main problem (Benson and Grieve, 2016c) which is resisting this project delivery. To discover the current interoperability challenges in the Australian healthcare industry, this comparative study is conducted on Health Level 7 (HL7) messaging models such as HL7 V2, V3 and FHIR (Fast Healthcare Interoperability Resources). In this study, interoperability, security and privacy are main elements compared. In addition, a case study conducted in the NSW Hospitals to understand the popularity in usage of health messaging standards was utilised to understand the extent of use of messaging standards in healthcare sector. Predominantly, the project used the comparative study method on different HL7 (Health Level Seven) messages and derived the right messaging standard which is suitable to cover the interoperability, security and privacy requirements of electronic health record. The issues related to practical implementations, change over and training requirements for healthcare professionals are also discussed

Lumir: The EHR-S In The Basilicata Region

The Lucania – Medici in Rete (LuMiR) project aims to support the changing environment in the Italian National Health Systems, embodying a shift from organisation-centric to patient-centric healthcare service delivery in the Basilicata Region. The project main objective is to foster collaborative, cross-organizational and patient-centric healthcare processes, with a suite of shared e-services supporting the interoperability of active stakeholders’ IT applications and the exchange of patient related clinical information. In the paper the LuMiR project approach and its aim to overcome some limitations of the EHR-S national recommendation are discussed. The methodology adopted in the design and development of the LuMiR system to comply with institutional constraints and to better support a gradual change in the daily working practice of healthcare professionals is described, together with details on the LuMiR system architecture and remarks on the interventions scheduled to cope with possible hindrances for the large scale adoption of the LuMiR system itself